Outcomes in Octogenarians and the Effect of Comorbidities After Intact Abdominal Aortic Aneurysm Repair in the Netherlands: A Nationwide Cohort Study

Abstract

WHAT THIS PAPER ADDS This paper examined retrospectively the outcomes of octogenarians that underwent either open surgical repair or endovascular repair for an intact abdominal aortic aneurysm in an obligatory nationwide registry, reflecting daily clinical practice in the Netherlands. The study showed that besides an increased age, comorbidities were clearly associated with impaired peri-operative survival after both open surgical and endovascular repair.Objective: Age is an independent risk factor for mortality after both elective open surgical repair (OSR) and endovascular aneurysm repair (EVAR). As a result of an ageing population, and the less invasive nature of EVAR, the number of patients over 80 years (octogenarians) being treated is increasing. The mortality and morbidity following aneurysm surgery are increased for octogenarians. However, the mortality for octogenarians who have either low or high peri-operative risks remains unclear. The aim of this study was to provide peri-operative outcomes of octogenarians vs. non-octogenarians after OSR and EVAR for intact aneurysms, including separate subanalyses for elective and urgent intact repair, based on a nationwide cohort. Furthermore, the influence of comorbidities on peri-operative mortality was examined. Methods: All patients registered in the Dutch Surgical Aneurysm Audit (DSAA) undergoing intact AAA repair between 2013 and 2018, were included. Patient characteristics and peri-operative outcomes (peri-operative mortality, and major complications) of octogenarians vs. non-octogenarians for both OSR and EVAR were compared using descriptive statistics. Multivariable logistic regression analyses were used to examine whether age and the presence of cardiac, pulmonary, or renal comorbidities were associated with mortality. Results: This study included 12 054 EVAR patients (3 015 octogenarians), and 3 815 OSR patients (425 octogenarians). Octogenarians in both the EVAR and OSR treatment groups were more often female and had more comorbidities. In both treatment groups, octogenarians had significantly higher mortality rates following intact repair as well as higher major complication rates. Mortality rates of octogenarians were 1.9% after EVAR and 11.8% after OSR. Age ! 80 and presence of cardiac, pulmonary, and renal comorbidities were associated with mortality after EVAR and OSR. Conclusion: Because of the high peri-operative mortality rates of octogenarians, awareness of the presence of comorbidities is essential in the decision making process before offering aneurysm repair to this cohort, especially when OSR is considered.

Endovascular aneurysm repair using the Gore Excluder Conformable Abdominal Aortic Aneurysm Endoprosthesis with active control system in octogenarians with highly angulated aneurysm neck: a UK single-centre experience

“…However, our results were similar to those from the EUROSTAR data, which showed that the complication rate was somewhat higher among octogenarians compared with that among younger patients. 9 A similar pattern was also reported by Alberga et al 16 who observed a statistically significant higher rate of major complications after EVAR in octogenarians compared with nonoctogenarians.…”

AAA Revisited: A Comprehensive Review of Risk Factors, Management, and Hallmarks of Pathogenesis

“…Besides advanced age and presence of cardiac, pulmonary, and renal comorbidities, frailty and preoperative functional status are predictors of postoperative morbidity and mortality [ 302 , 303 , 304 ]. Female sex, aneurysm diameter, and smoking habits are also associated with poor long-term survival.…”

Identifying Women at High Risk of 90 Day Death after Elective Open Abdominal Aortic Aneurysm Repair: A Multicentre Case Control Study

“…Advanced age is a well known risk factor for peri-operative death after AAA surgery, 10 , 11 , 12 , 13 and particularly dangerous when accompanied by comorbidity. The impact of comorbidities was demonstrated in a study showing a 14.8% mortality risk after AAA repair in octogenarians with comorbidities vs. 3.8% in octogenarians without comorbidities.…”

“…The impact of comorbidities was demonstrated in a study showing a 14.8% mortality risk after AAA repair in octogenarians with comorbidities vs. 3.8% in octogenarians without comorbidities. 10 …”